OBJECTIVE PAGE
LESSON ONE
Autism Recognition
and Response:
Understanding Autism
DOMAIN: COGNITIVE
LEVEL OF LEARNING: COMPREHENSION
MATERIALS
Overhead projector; chalkboard or flip chart; Autism & Law
Enforcement: Roll Call Briefing video, Debbaudt/Legacy
Productions, 2004; Autism, Advocates, and Law
Enforcement Professionals, Dennis Debbaudt; Dangerous
Encounters - Avoiding Perilous Situations with Autism, Bill
Davis and Wendy Goldband Schunick; Dealing with Unique
Challenges Such as Autism, Virginia Office of Emergency
Medical Services, Virginia Department of Health; Autism
Myths and Realities, Robert Needleman, M.D.;
www.drspock.com; Kyle Westphale Foundation
(www.kylestreehouse.org); Autism and PDD Support
Network (www.autism-pdd.net); Why Does Chris Do That?
Some Suggestions Regarding the Cause and Management
of the Unusual Behavior of Children and Adults with Autism
and Asperger’s Syndrome, by Tony Attwood, Revised 2003
edition, Autism Society of North Carolina
(www.autismsociety-nc.org); Autism Society of America
(www.autism-society.org).
TERMINAL OBJECTIVE
The emergency responder shall correctly identify the
behavioral symptoms and characteristics of a child or adult
with autism.
Autism Recognition and Response: Understanding Autism
Page 1 of 9
OBJECTIVE PAGE
ENABLING OBJECTIVES
1.
The emergency responder shall correctly identify in
writing, the definition of autism and how it may affect an
individual.
2.
The emergency responder shall correctly identify in
writing, the behavioral symptoms and characteristics of
a child or adult with autism.
Autism Recognition and Response: Understanding Autism
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OBJECTIVE PAGE
LESSON ONE
Autism Recognition
and Response:
Understanding Autism
MOTIVATION
Autism is the fastest-growing disability in the United States.
Currently, more than 1.5 million children and adults in this
country have been diagnosed with autism or another form of
Pervasive Developmental Disorder (PDD), and the diagnosis
rate is rising 10-17% each year. In North Carolina alone,
nearly 50,000 people are living with Autism. With this, the
likelihood of encountering an individual with autism during an
emergency situation increases exponentially.
A UT ISM RECOG NIT ION
AND RESPONSE
L esson One: Understanding
A utism
OHT 01
1
The fastest growing disability in
the United States
It is imperative that emergency responders learn to
recognize the “classic” signs of autism, so that the proper
response techniques can be used to ensure the responder's
safety as well as the safety of the individual with autism.
ƒ More than 1.5 million children & adults in
this country have been diagnosed with
Autism or another form of PDD.
ƒ Approximately 1 out of 150 born today has
some form of Autism.
ƒ It is 4 times more prevalent in boys than
girls.
ƒ In North Carolina alone, nearly 50,000
people are living with Autism.
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OHT 02
PRESENTATION
ENABLING OBJECTIVE #1
The emergency responder shall correctly identify in writing,
the definition of autism and how it may affect an individual.
1.
2.
Point out that autism is one of several disorders that fall
under the umbrella category of Pervasive
Developmental Disorders (PDD).
List and explain similar terms used with Pervasive
Developmental Disorders (PDD).
a)
Autism Spectrum Disorder.
b)
Asperger’s Syndrome.
c)
High Functioning Autism.
d)
Low Functioning Autism.
Autism Recognition and Response: Understanding Autism
What is Autism?
ƒ Autism is one of several disorders that falls
under the umbrella category of Pervasive
Development Disorder (PDD).
ƒ It refers to a group of developmental
disabilities that affect a person’s ability to
understand what they see, hear, and sense.
In other words, it affects communication
(verbal & non-verbal), social interaction, and
behavior.
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3
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Similar Terms
ƒ
ƒ
ƒ
ƒ
ƒ
Asperger’s Syndrome
Childhood Disintegrative Disorder
Rett’s Syndrome
High Functioning Autism
Low Functioning Autism
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3.
Explain that autism is a complex developmental brain
disorder that begins in early childhood and persists
throughout adulthood.
4.
Explain that autism generally affects three crucial areas
of development.
a)
Verbal and non-verbal communication.
b)
Social interaction.
c)
Creative or imaginative play is affected.
5.
Point out that autism may share some similar
characteristics with other PDDs.
a)
Asperger's Syndrome.
b)
Childhood Disintegrative Disorder.
c)
Rett's Syndrome.
d)
PDD - Not Otherwise Specified.
Autism may share some similar
characteristics with other PDD’s:
ƒ
ƒ
ƒ
ƒ
Asperger’s Syndrome
Childhood Disintegrative Disorder
Rett’s Syndrome
PDD – Not Otherwise Specified (PDD-NOS)
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OHT 05
NOTE: More information about PDDs can be found at the
National Dissemination Center for Children with
Disabilities website.
6.
Point out that males are four times more likely than
females to be diagnosed with autism.
7.
Discuss that all individuals with autism experience
developmental delays which can present themselves in
various ways.
a)
Language development.
b)
Self-help skills such as dressing, toilet training,
and brushing teeth.
c)
Academics.
d)
Injurious behavior to self or others.
8.
Point out that, at this time, there is no known single
cause for autism, but it is generally accepted to be
caused by abnormalities in brain structure or function.
a)
Brain scans show differences in the shape and
structure of the brain in autistic versus nonautistic children.
b)
Researchers are investigating a number of
theories, including the link between heredity,
genetics, and medical problems.
9.
Identify the most prevalent misconceptions about
autism.
Autism Recognition and Response: Understanding Autism
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a)
b)
c)
d)
Cold or distant parenting causes autism. It was
once thought that parents who were unloving
created such an unattractive world to the child
that the child became autistic. This theory couldn't
be farther from the truth and is no longer
considered credible. Children from all walks of life
are diagnosed with autism, and parents with
autistic children also have children who are not
autistic. Today we know that parents are not to
blame for causing autism.
All autistic people are like the character portrayed
by Dustin Hoffman in the movie Rain Man.
Because that character had autism and exhibited
extraordinary abilities sometimes found in
individuals with autism (known as splinter skills,
which can include perfect memory, mathematical
calculation, and art/music), it is believed that all
autistic people have abilities like these.
Autistic children never learn to talk. Many autistics
have the ability to speak and learn to talk and
communicate successfully with others.
People with autism do not smile or show affection.
People with autism do indeed feel and emotion.
Because of the nature of the disorder, it may take
longer for attachments and bonds to form, but
many autistic children show affection right from
the beginning, and many others demonstrate
affection as they develop.
Misconceptions about Autism
ƒ Cold or distant parenting causes autism.
– Children from all walks of life are diagnosed
with autism, and parents with autistic children
also have children who are not autistic.
OHT 06
6
Misconceptions about Autism
ƒ All autistic people are like the character
portrayed by Dustin Hoffman in the movie
“Rain Man”.
– Because the character had autism and
exhibited extraordinary abilities sometimes
found in individuals with autism, it is believed
that all autistic people have abilities like these.
7
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8
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9
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Misconceptions about Autism
ƒ Autistic children never learn to talk.
– Many autistics have the ability to speak and can
talk and communicate successfully with others.
Misconceptions about Autism
ƒ People with autism do not smile or show
affection.
– People with autism do indeed feel and
experience emotion. Because of the nature of
this disorder, it may take longer for attachments
and bonds to form, but many autistic children
show affection right from the beginning, and
many others demonstrate affection as they
develop.
Reference: Autism Myths and Realities, Robert Needleman,
M.D; Autism Society of America (autism-society.org).
PRESENTATION
ENABLING OBJECTIVE #2
The emergency responder shall correctly identify in writing,
the behavioral symptoms and characteristics of a child or
adult with autism.
1.
Explain that every person with autism is an individual
and has a unique personality and combination of
characteristics.
2.
Explain that autism is a spectrum disorder, meaning
that, although it is defined by a certain set of behaviors,
Autism Recognition and Response: Understanding Autism
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the symptoms and characteristics of autism can
present themselves in a wide variety of combinations
and severity.
NOTE: This is a crucial point to emphasize when
teaching emergency responders to recognize autism
behavioral symptoms. No two autistic individuals will
act completely the same or display the same
characteristics and capabilities.
3.
Point out that people with autism process information in
unique ways.
a)
Because their processes are different from our
own, they respond to their environment in
unpredictable and widely differing ways.
b)
In some cases, aggressive and/or self-injurious
behavior may result.
Spectrum Disorder
ƒ Defined as a certain set of behaviors
ƒ Symptoms and characteristics can present
themselves in a wide variety of
combinations and severity
OHT 10
10
Behavioral Indicators
ƒ Does not speak or has unusual verbal
expression
ƒ Says things out of context or recites
conditioned responses
ƒ Body language may appear stilted
ƒ Facial expressions may be flat or appear
disinterested
ƒ Provides little or no eye contact
OHT 11
11
People with autism process
information in unique ways
ƒ Their processes are different from our own,
therefore they respond to their environment
in unpredictable and widely differing ways.
ƒ In some cases, autistic individuals may
engage in aggressive and/or self-injurious
behavior.
OHT 12
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4.
Explain that sensory integration is defined as the
interaction of two or more sensory processes in a
manner that enhances the adaptiveness of the brain.
a)
Each sense works with the others to form a
composite picture of who we are physically,
where we are, and what is going on around us.
b)
Sensory integration is the critical function of the
brain that is responsible for producing this
composite picture.
c)
It is the organization of sensory information for
on-going use.
5.
Point out that for most of us, effective sensory
integration occurs automatically, unconsciously, and
without effort.
6.
Point out that sensory integration problems are
common in individuals with autism. Their information
processing is inefficient, demanding effort and attention
with no guarantee of accuracy.
7.
8.
Explain that these integration problems in an autistic
individual result in one or more of the senses being
either hypersensitive or hyposensitive.
Discuss the possibility that an autistic individual's
unusual sensory processes may result in unpredictable
responses to their environment.
Autism Recognition and Response: Understanding Autism
Sensory Integration
ƒ Sensory integration is defined as the
interaction of two or more sensory
processes in a manner that enhances the
adaptiveness of the brain.
ƒ Each sense works with the other to form a
composite picture of who we are
physically, where we are, and what is going
on around us.
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OHT 13
Sensory Integration
ƒ Sensory integration problems are common
in autistic individuals.
ƒ Their process is inefficient, demanding
great effort and attention with no
guarantee of accuracy.
ƒ Sensory integration problems result in one
or more of the senses being overly
sensitive (hypersensitive) or under sensitive
(hyposensitive).
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Sensory Integration
ƒ Due to the person’s unusual sensory
processes, unpredictable responses during
an emergency situation may occur.
– The flashing lights and/or sirens on a fire truck
or ambulance could be upsetting
(hypersensitivity).
– The person may continuously rock back and
forth, or rub/scratch their skin. (hyposensitivity).
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9.
Point out that some individuals with autism are
particularly hypersensitive to sound, finding even the
most ordinary daily noises painful, while others may be
extremely sensitive to light.
10.
Discuss the implications of these hypersensitivities in
regards to the emergency responder’s use of flashing
lights and sirens.
11.
Explain that some individuals with autism will engage in
self-stimulating behaviors in order to provide needed
sensory stimulation.
12.
13.
Point out that there are two theories suggesting why an
autistic person engages in self-stimulating behaviors.
a)
Self-stimulating behavior provide the
hyposensitive autistic person with sensory
stimulation he or she feels is lacking.
b)
It calms the hypersensitive autistic person when
the environment is too stimulating and the person
is in a state of sensory-overload. The behaviors
are used to help block out the over-stimulating
environment and focus his or her attention inward.
Discuss that the single most defining self-stimulating
behavior of an individual with autism is repetitious, selfstimulating behavior.
a)
Repetitive body movements or repetitive
movement of objects.
Self-Stimulating Behaviors
ƒ Some individuals with autism will engage in
self-stimulating behaviors in order to provide
needed sensory stimulation.
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17
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Self-Stimulating Behaviors
ƒ Two theories behind why autistic individuals
perform self-stimulating behaviors are:
– To provide the hyposensitive person with the
sensory stimulation he or she feels is lacking.
– To calm the hypersensitive person when the
environment is too stimulating and the person is
in a state of sensory-overload (i.e., the
behaviors are used to block out the overstimulating environment and focus the
individual’s attention inward).
Self-Stimulating Behaviors
ƒ The single most defining characteristic of an
individual with autism is repetitious,
self-stimulating behavior.
18
14.
Identify several self-stimulating or stereotypic behaviors
that an autistic individual may engage in.
a)
Staring at lights or off into space for long periods
of time.
b)
Repetitive blinking.
c)
Moving fingers in front of the eyes.
d)
Hand-flapping or snapping fingers.
e)
Tapping ears.
f)
Making vocal sounds.
g)
Rubbing the skin with one's own hands or another
object or constant scratching.
h)
Rocking the entire body front to back or side to
side.
i)
Placing body parts or objects in one's mouth.
j)
Licking or smelling objects.
Autism Recognition and Response: Understanding Autism
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Self-Stimulating Behaviors
ƒ Staring at lights or off into space for long periods of
time
ƒ Repetitive blinking
ƒ Moving fingers in front of the eyes
ƒ Hand-flapping or snapping fingers
ƒ Tapping ears
ƒ Making vocal sounds
ƒ Rubbing the skin with one’s own hands or another
object or constant scratching
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Self-Stimulating Behaviors
ƒ Rocking the entire body front to back or side to
side
ƒ Placing body parts or objects in one’s mouth
ƒ Licking objects or smelling objects
ƒ Sniffing oneself or other people
ƒ Lining up objects on the floor
ƒ Staring off into space for long periods of time
ƒ Repeating particular sounds or phrases
Page 7 of 9
k)
l)
m)
Sniffing oneself or other people.
Lining up objects on the floor.
Repeating particular sounds or phrases.
15.
Point out that while many people with autism can look
consistently at objects for long periods of time, they
often make little eye contact with other people.
16.
Point out that some autistic individuals will be nonverbal.
a)
This does not mean that they are unintelligent.
b)
Responders may have to consider alternatives to
verbal communication such as signing, typing, or
the use of pictures or storyboards.
17.
18.
Explain how some individuals mildly affected by autism
may exhibit only slight delays in language development
but greater challenges with social interactions.
a)
They may have difficulty initiating and maintaining
a conversation.
b)
Their communication is often described as talking
at others instead of to them. For example, a
monologue on a favorite subject that continues
despite attempts by others to interject comments.
c)
They may not be able to express their needs or
thoughts clearly.
d)
They may repeat words or phrases.
e)
Often they will make little eye contact with people,
even people they know and are comfortable with.
f)
They may have difficulties interacting with others
for significant periods of time.
g)
They may appear to lack an awareness of other
people around them.
Communication
ƒ Some autistic individuals will be non-verbal.
ƒ This does not mean that they are
unintelligent.
ƒ Responders may have to consider
alternatives to verbal communication, such
as signing, typing, or the use of pictures.
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Communication
ƒ Some individuals mildly affected by autism
may exhibit only slight delays in language
development, yet have greater challenges
with social interactions.
Social Interaction
ƒ They may have difficulty initiating and/or
maintaining a conversation.
ƒ Their communication is often described as
talking at others instead of to them.
ƒ They may not be able to express their needs
or thoughts clearly.
ƒ They may repeat words or phrases.
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OHT 23
Social Interaction
ƒ Often they will make little eye contact with
people, even people they know and are
comfortable with.
ƒ They may have difficulties interacting with
others for significant periods of time.
ƒ They may appear to lack an awareness of
other people around them.
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OHT 24
Point out that most autistic people don't interact with
others for significant periods of time. Autistics will often
halt an interaction by walking away and engaging in
self-stimulating behavior.
Reference: Autism Society of America (www.autismsociety.org); Kyle Westphale Foundation
(www.kylestreehouse.org); Autism and PDD Support
Network (www.autism-pdd.net); Why Does Chris Do That?
Some Suggestions Regarding the Cause and Management
of the Unusual Behavior of Children and Adults with Autism
and Asperger’s Syndrome, by Tony Attwood, Revised 2003
Autism Recognition and Response: Understanding Autism
Page 8 of 9
edition; Autism Society of North Carolina
(www.autismsociety-nc.org); Autism Myths and Realities,
Robert Needleman, M.D.; www.drspock.com.
SUMMARY
Whether responding to a natural disaster or a uniquely
human engineered one, it is imperative that emergency
responders understand what autism is and learn how to
recognize the signs of this disorder in order to better assist
these individuals during an emergency. With preparation and
training regarding the needs of these individuals and the
special precautions that must be taken, emergency
responders can increase the chances of a safe and
successful encounter when summoned for everyone
concerned.
Autism Recognition and Response: Understanding Autism
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